Provider Demographics
NPI:1346215993
Name:GOOEN, RITA (MSN APRNC)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:
Last Name:GOOEN
Suffix:
Gender:F
Credentials:MSN APRNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860
Mailing Address - Country:US
Mailing Address - Phone:973-579-2456
Mailing Address - Fax:973-579-0167
Practice Address - Street 1:157 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860
Practice Address - Country:US
Practice Address - Phone:973-579-0167
Practice Address - Fax:973-579-0167
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC02337000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6629202Medicaid
G0656457Medicare ID - Type Unspecified